Human biology is fascinating, and biology specific to birth even more so. So many systems and tissues and biochemical interactions work together to create and expel an entire new being! In the past several weeks we have been discussing the umbilical cord; Delayed Cord Clamping, Delayed Cord Clamping, or Premature Cord Amputation?, and Don’t Cut the Lifeline! Resuscitation, Leaving the Cord Intact, and Advocating for Yourself. The way that medicine currently approaches the umbilical cord indicates little knowledge of how the cord works.
Inside the human umbilical cord are two arteries and one vein. The vein carries oxygenated blood from the placenta to the baby, and the arteries carry waste products and deoxygenated blood away from the baby, back to the placenta. Fetal circulation is very complex and involves an opening between the two sides of the heart, and mixing of oxygenated and deoxygenated blood (a misleading term; the blood oxygen content of ‘deoxygenated’ blood is lower, but not absent, however ‘deoxygenated’ is an accepted medical term). In the first moments after birth, an enormous physiological shift happens in the baby, the umbilical cord, and the placenta in order to ensure a baby breathes, exchanges gases, and circulates blood on its own for the first time. Part of that shift involves Wharton’s Jelly.
Wharton’s Jelly is a clear, mucous tissue that insulates and protects the umbilical arteries and vein (source). When exposed to the cooler temperatures outside the mother’s body, Wharton’s Jelly will collapse the venous structures within the cord, physiologically clamping it within 5 to 20 minutes after birth (Wharton’s Jelly and Umbilical Cord, Postnatal Occlusion). Thus, cord clamping is not actually necessary at all! Wharton’s Jelly consists of mucopolysaccharides (fats), white blood cells, and stem cells. It looks like clear jelly, and can be seen clearly in this photo of a Wharton’s Jelly cyst:
In a cyst the Jelly remains a mucousy liquid rather than hardening as it should in the minutes after birth. Eventually, the umbilical arteries and vein collapse and the Wharton’s Jelly hardens, the umbilical cord dries over a period of several days to a week, and detaches.
Write About Birth wrote a post on Wharton’s Jelly, stating that
the great thing about this substance is that it essentially provides a physiological cord clamp. It reacts to changes in temperature, and ensures that the internal structure of the baby’s cord collapses. Of course, childbirth is exactly that event that caused those changes in temperature. After the cord stops pulsing, it turns limp and white. Wharton’s jelly is the substance that means that clamping the umbilical cord is not necessary. The human body does this all by itself!
Clamping and cutting the cord then seems like a hustle and bustle which certainly interferes with the hormonal and emotional events happening in the first minutes after birth and does not seem to have a physiological purpose beyond cleaning up and moving on. The focus in the room directly after a baby is born should be the baby and the woman who just gave birth. When at all possible, a peaceful and joyous span of time should follow birth, and not hustle and bustle and clamping and cleaning. Birth works. Women’s bodies work well. Umbilical cords work the way they are meant to. And, in the vast majority of cases, no one needs any emergent care. Maternity care providers can watchfully wait for those first minutes to pass undisturbed, and do no harm.